Jun. 14, 2012 - 03:05PM
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Last Updated: Jun. 14, 2012 - 03:05PM |

Q. My mother got [Civilian Health and Medical Program of the Uniformed Services coverage] through her second husband. He died in the 1990s, and she became eligible for Tricare as his widow. A few years later, she got Medicare, and they canceled her military insurance. An officer friend thinks Tricare was wrong to cancel her insurance. Could she still be eligible?

A. It sounds like your mother turned 65, became entitled to Medicare, and thus lost her Tricare eligibility prior to Oct. 1, 2001, when Congress created Tricare for Life.

The best way for her to find out if she is still eligible is to call the Defense Enrollment Eligibility Reporting System at 800-538-9552. They can explain to her exactly how the Tricare eligibility rules apply in her case.

Q. I have other health insurance, and when I file with Tricare as second payer, I always have a problem getting copies of the original bills from my doctor's office. The other plan's explanation of benefits says what medical services I got and the amounts it paid, so why isn't that enough for Tricare's use? Why are copies of the original bills required?

A. The way services are listed on the other plan's EOB may not report a detailed description of the medical services you actually received. For example, there may be several different services labeled simply as "office visit" on the other plan's EOB. Tricare and the other plan likely allow different amounts for each service, so the words "office visit" and the amount allowed by the other plan do not tell Tricare exactly what kind of medical service the patient received.

Tricare must know exactly what services you received to determine the amount it would have allowed for each of them if Tricare had been your primary coverage. If, as I suspect, the problem arises between you and the office staff, perhaps explaining it to your doctor will remedy the situation.

Q. My wife is eligible for Tricare because of my military service. What will happen to her eligibility if I die because of a condition that is not service-connected?

A. Your death, or the reason for it, will have no effect on your wife's Tricare eligibility. Under current law, she can remain eligible for Tricare for the rest of her life unless she remarries. If she remarries, she will immediately lose her Tricare eligibility under your sponsorship.

Her eligibility under your sponsorship cannot be restored, even if her second marriage is ended by divorce or death.

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